In the 1990s, Portugal was in the throes of a national crisis, averaging 360 drug overdose deaths a year in a country of 10 million. Today, it has one of Europe’s lowest rates of drug, alcohol and tobacco use and the number of overdose deaths in 2016 was 26. In a weeklong series from Portugal, Vancouver Sun columnist Daphne Bramham looks at the lessons to be learned from the country’s radical approach to addiction treatment.

Getting it right requires plumbing the depths of one’s soul to produce the right sounds, the right passion. For guitar player Francisco, heroin and other drugs helped him get there.

Francisco is a former heroin user and Fado guitar player who came to In-Mouraria, a harm-reduction and treatment centre, for legal help and ended up getting more than that.Daphne Bramham /
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“It’s a dangerous life because all of the music is an expression of the feelings and sensitivities, so there is a propensity to use drugs,” he said. “The drugs made me have more sensitivity. They help me with my music. In so much feeling, it helps me to play and expand what I play … like Jim Morrison and others.

“I experimented because I wanted to see with my eyes or to get into a mental situation that would give me some news about feelings that I don’t know. Most musicians die with drugs, not like marginalized people, but because they are trying to conciliate these feelings into their work.”

Now 55, Francisco said that GAT’s In-Mouraria office saved his life. GAT is a non-profit organization set up to provide harm-reduction programs to users like him. Its graffiti-decorated office is near the heart of Mouraria, Lisbon’s medieval quarter of narrow, cobbled streets lined with houses that were once home to sailors and miscreants, the place where Fado is believed to have been born.

At the harm-reduction centre, In-Mouraria, needles, hash pipes, condoms and other supplies are handed out to lessen the risks of users contracting diseases or overdosing.Daphne Bramham /
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But, unlike in Canada, harm reduction here includes much more. It provides a pathway to substance abuse treatment, either as an outpatient or in a residential recovery program, and to help with other needs as well.

Francisco came here looking for legal help, which the staff helped him get.

His father had died, throwing him into depression that deepened as his estranged siblings tried to claim the house that Francisco had lived in all his life. His drug use escalated in an attempt to salve his pain and grief.

As he talked about his father’s death, Francisco wept.

“Heroin is a drug that is so nice that it’s dangerous,” he said. “One day, you wake up and the drug controls you. The first thing you want to do is go and inject. … Every day, when I wake up, I think I have come to the jungle (with the danger always lurking) even when I go to the café I have a little fear (of relapsing).”

With legal help, Francisco eventually got sole title to the house. It means that he has some stability in his life though he still uses drugs, is unemployed and lives on 180 euros a month from social assistance bolstered by what he makes busking and playing the odd gig.

But he got much more than legal help from GAT. His hepatitis C has been cured. By coming here, Francisco said his drug use has been reduced to smoking hash occasionally and having the odd drink.

Adriana Curado is GAT’s project coordinator, with a doctorate in clinical psychology.

“Harm reduction is about taking care of people regardless of whether they are using drugs or not,” she said.

The cramped office is filled with comfortable sofas. There are books that can be borrowed and half a dozen loaves of bread on a shelf. The needles, condoms and hash pipes are kept in a locked, glass counter.

Eighty per cent of those who come here are men over 40 “with long careers in drugs” and little education, Curado said. Most are unemployed or have no formal job history.

“We’re working in a context of poverty,” she said, which is why GAT is lobbying hard for supervised injection sites for those who have nowhere else to use drugs and more availability of naloxone to reverse the effects of opioid overdoses.

Curado admitted there is a naloxone kit on site even though GAT isn’t supposed to allow drugs to be injected here.

“We have it because we are doing civil disobedience,” she said. “We need to have it because it is a life-saving medication and there is no reason why it should not be available when needed.”

Naloxone is an antidote to an opioid overdose and has proven important during Canada’s epidemic of deaths from illicit fentanyl. Increased availability is something that Portugal’s drug policy director João Goulão said is under consideration. But both he and Curado noted that Portugal’s overdose death rate is low — 40 in 2016 — and that fentanyl has yet to hit this country.

Lisbon is a colourful and graffiti-rich city, especially the neighbourhood where In-Mouria, a harm-reduction centre is located.Daphne Bramham /
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Unlike Canada, where harm reduction has been front and centre of its drug policies, Portugal has put few resources in harm reduction, instead choosing to focus on prevention, education, treatment and recovery. It has resulted in a steep reduction in injection drug use with the number of high-risk opioid users now estimated at 33,290, down from an estimated 100,000 in the late 1990s.

An estimated 1.35 million syringes a year are distributed by outreach teams and organization’s like Curado’s and the most recent data indicate that HIV diagnoses attributed to injection drug use has dropped to 30 in 2016 from nearly 500 in 2006.

Despite those successes, Curado is critical of Portugal’s drug policies.

“Portugal is still under a prohibitionist paradigm. Drugs aren’t legal and people are still penalized,” she said, noting that the police still collect people off the streets and give tickets that require them to go to the Commission for the Dissuasion of Drug Addiction.

Although the commission is supposed to be a fast track to services for those who are willing to accept help, Curado said, “The commission penalizes people and I don’t agree with that. … It’s not my role or our role to tell people to stop using drugs.”

What she and her organization want is full legalization of all drugs, a regulated and legal drug market. Of course, she added, “One country can’t go it alone.”

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